Volume 24

The primary care team at the local GP clinic serves as a first point of healthcare contact for rural communities in Ireland, but changes in financial supports to GP practices in 2010, and a history of structural urbanism, resulted in many rural general practices struggling for viability. This Policy Report presents a brief account of advocacy led by rural GPs and their communities in Ireland, and the political and policy implications of their efforts.

The early consideration of parechovirus in infants presenting with undifferentiated abdominal illness atypical for sepsis or surgical cause may facilitate supportive management in some rural hospital contexts without need for transfer. This Clinical Case Report describes a rare presentation of parechovirus infection and its management in an 11-day-old infant in an Australian rural hospital.

In Canada, an estimated 20% of the population experiences a mental health and/or substance use (MHSU) disorder, such as generalized anxiety disorder or major depressive disorder, in any one year. People living in rural regions tend to have disproportionately higher rates of mental health challenges, poorer mental health outcomes and a higher risk of a fatal toxic drug poisoning compared with urban areas. Compounding these inequities, MHSU services may be absent, difficult to access, or inadequate in rural areas. Although literature reviews have been conducted on rural nursing (ie. on rural health nursing research, rural continuing nursing education, and evidence-based practice and rural nursing), less attention has been paid to rural MHSU nursing. This Scoping Review examines the rural MHSU nursing literature.

Clinical guidelines recommend pulmonary rehabilitation for the management of the long-term effects of critical illness associated with COVID-19. It has been reported that supervised pulmonary rehabilitation programs improve lung function, exercise capacity, and exertional dyspnea in patients with severe (requiring hospital treatment) or critical (requiring admission to an intensive care unit and even ventilation) COVID-19. Although in-person rehabilitation services proved difficult to provide during the pandemic owing to health system overload, telerehabilitation emerged as having great potential to stop this gap. The lessons about telerehabilitation learned during the COVID-19 pandemic are also likely to benefit rural patients, for whom in-patient rehabilitation can also be challenging owing to inequities in healthcare access because of workforce maldistribution and distances to clinics. This Original Research article compares the long-term results of different types of telerehabilitation programs on hemodynamic and clinical parameters associated with exertion and physical functions in discharged COVID-19 patients.

Access to care is an ongoing challenge for many Indigenous peoples living in remote communities. Equitable health care for Indigenous people must be culturally safe and trauma informed, while also being accessible. This study uses a narrative approach to investigate First Nations peoples’ perspectives on the use of virtual care and the development of a therapeutic relationship in the context of virtual physiotherapy. This article offers insight into how to deliver care virtually while ensuring cultural safety, and working with the limitations of virtual care.

During pregnancy, the risk of iron deficiency increases because of the elevated demand for iron in the mother for the formation of red blood cells, and placenta and fetus development. In Indonesia in 2018, 84.6% of pregnant women aged 15–24 years experienced pregnancy anaemia. Following global recommendations, the Indonesian government has made several efforts to reduce iron deficiency anaemia in pregnancy. One of these is providing pregnant women with daily iron–folic acid supplementation (IFAS) during antenatal care visits, though the success of this program has been challenged by a lack of coverage, various brands in which iron–folic acid content does not meet the standard, consumption that does not start early in pregnancy, low quality of IFAS education and lack of records. There is also some evidence that IFAS can be influenced by maternal education and household wealth. This Original Research study investigates social determinants and socioeconomic inequality in adherence to antenatal IFAS in rural and urban settings in Indonesia. Findings from this study may contribute to formulating appropriate policies and interventions to enhance antenatal IFAS adherence, and therefore better maternal nutrition and health outcomes.

The WHO defines traditional, complementary and integrative medicines as a broad set of healthcare practices from different cultures used for health promotion, prevention and recovery. In the Brazilian Amazon, traditional healing practices, often using medicinal plants, are common for solving physical, spiritual and magical or religious problems. Better understanding of traditional medicine can contribute to the improvement of health care of traditional peoples and communities, and subsidize the practice of professionals who work mainly in the context of primary care and other levels of health care. This Review article identifies, maps and synthesizes scientific evidence on the use of traditional medicine as therapeutic resources when used by traditional communities of the Brazilian Amazon.

A OMS define as medicinais tradicionais, complementares e integrativas como um amplo conjunto de práticas de diferentes culturas usadas para promoção, prevenção e recuperação da saúde. Na Amazônia brasileira, as práticas tradicionais comumente utilizam plantas medicinais para resolução de problemas físicos, espirituais e mágicos ou religiosos. A melhor compreensão da medicina tradicional pode contribuir para a melhora do cuidado em saúde de comunidades tradicionais e subsidiar a prática de profissionais que trabalham principalmente no contexto da atenção primária e de outros níveis de atenção à saúde. Este artigo de revisão identifica, mapeia e sintetiza a evidência científica sobre o uso da medicina tradicional como recurso terapêutico utilizado por comunidades tradicionais da Amazônia brasileira.

The WHO defines traditional, complementary and integrative medicines as a broad set of healthcare practices from different cultures used for health promotion, prevention and recovery. In the Brazilian Amazon, traditional healing practices, often using medicinal plants, are common for solving physical, spiritual and magical or religious problems. Better understanding of traditional medicine can contribute to the improvement of health care of traditional peoples and communities, and subsidize the practice of professionals who work mainly in the context of primary care and other levels of health care. This Review article identifies, maps and synthesizes scientific evidence on the use of traditional medicine as therapeutic resources when used by traditional communities of the Brazilian Amazon.

This statement, written by delegates at the 2023 'Are You Remotely Interested' Remote Health Conference in Queensland, Australia, is an urgent call for recognition and support for rural generalism, including specific training and continuing professional development through interprofessional education strategies located in rural and remote communities.

Abortion is not routinely funded, provided or monitored by Australia’s public health system. Less than 10% of GPs in 2021 had undertaken the mandatory training to prescribe for medical abortion and most procedural abortion services are delivered by independent providers at considerable out-of-pocket cost to the consumer. GPs that are conscientious objectors to providing abortion services are legally obliged to refer to other available services but, for rural GPs, the absence of feasible referral pathways means this obligation can easily remain unfulfilled. This Original Research study investigates the experiences of rural primary care providers who become the ‘first point of contact’ for women with unintended pregnancy and, irrespective of their knowledge, interest or expertise in abortion provision, are charged with the task of ensuring abortion-seekers in their rural communities reach the services they need in an unaccommodating health system.

The COVID-19 pandemic began in 2020 and caused major disruptions to social activities, education, employment, and healthcare delivery. A concurrent ‘infodemic’ of misinformation (unintentionally false information) and disinformation (deliberately misleading information) about COVID-19 was also widespread. To help prepare for future infodemics, this Original Research article examines associations of health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in Northern Arizona, USA.

General practice (GP) plays a vital role in delivering improved community health outcomes, particularly in rural communities, where geographical barriers, lack of transport and increased distances to healthcare services lead to poorer health outcomes for rural dwellers compared with people living in urban areas. In Ireland, approximately 1 in 3 people live in rural areas and only 7% of rural people live within walking distance of the nearest GP clinic. It has been forecasted that by 2031, there will be a 46% increase in demand for primary care services across Ireland but the number of rural Irish GPs has been decreasing over the past two decades. This Original Research study explores the distribution of GP clinics among rural and urban populations in the Mid-West of Ireland and the impact on new travel distances if GP clinics were individually closed across the region.

Low back pain is an international public health issue affecting over half a billion people worldwide, and the burden of low-back-pain-related disability is increasing, particularly in low- and middle-income countries. A recent quantitative study in Suriname provided the first insights into the burden of musculoskeletal diseases in the country and found that low back pain is highly prevalent. Indigenous Peoples face numerous and unique barriers in seeking care for their low back pain. This Original Research article presents the results of a qualitative study that aimed to better understand the experiences of low back pain and care-seeking among Indigenous Peoples in Suriname by using a culturally relevant approach supported by the local traditional authority. The research was carried out in Galibi, a remote Kalinya Indigenous village in the north-east of Suriname.

A dor lombar é uma questão de saúde pública internacional que afeta cerca de 500 milhões de pessoas ao redor do mundo, e cuja carga de incapacidade está aumentando, particularmente em países de renda média e baixa. Um recente estudo quantitativo no Suriname forneceu as primeiras informações sobre a carga das doenças musculoesqueléticas no país e encontrou que a dor lombar é altamente prevalente. Indígenas se deparam com barreiras numerosas e únicas na procura por cuidado para a dor lombar. Este artigo original apresenta os resultados de um estudo qualitativo que objetivou uma melhor compreensão sobre as experiências de dor lombar e procura por cuidados entre indígenas do Suriname, utilizando uma abordagem qualitativa relevante apoiada pela autoridade tradicional local. A pesquisa foi realizada em Galibe, uma remota aldeia Kalinya no nordeste do Suriname.

El dolor lumbar es un problema de salud pública internacional que afecta a más de 500 millones de personas en todo el mundo, y la carga de discapacidad relacionada con el dolor lumbar está aumentando, en particular en los países de ingresos bajos y medios. Un estudio cuantitativo reciente en Surinam proporcionó los primeros conocimientos sobre la carga de enfermedad musculoesquelética en el país y descubrió que el dolor lumbar es muy prevalente. Los pueblos indígenas enfrentan numerosas y singulares barreras a la hora de buscar atención médica para su dolor lumbar. Este artículo de investigación original presenta los resultados de un estudio cualitativo que tuvo como objetivo comprender mejor las experiencias del dolor lumbar y la búsqueda de atención médica entre los pueblos indígenas de Surinam mediante el uso de un enfoque culturalmente relevante respaldado por la autoridad ancestral local. La investigación se llevó a cabo en Galibi, en una aldea indígena remota Kalinya en el noreste de Surinam.

Enduring inequities in rural healthcare provision, underpinned by an inadequately sized and fit-for-purpose workforce, are well known to those invested in or tasked with supporting the sustainability of rural communities. In this Commentary, the authors discuss what the rural GP shortage discourse has meant for bottom-up, community development approaches to strengthening the rural health workforce and top-down supports for improving rural healthcare quality. They explore how well the frame of the rural GP shortage marries with rural residents’ current health and social care needs, and the circumstances of rural GPs. They propose implementing several multi-level actions to further stimulate and promote a much-needed shift in discourse and power to alter investment and lead a future re-imagining of the rural health workforce.

Human papillomavirus (HPV), which can cause cancer, is the most prevalent sexually transmitted infection in the USA. Before the global COVID-19 pandemic disrupted cancer prevention and control systems, HPV-associated cancer incidence was rising in rural USA. However, understanding the burden of HPV-associated cancer in rural areas has been complicated by two factors: (1) ignoring heterogeneity within non-metropolitan populations, which might mask the excessive burden in small, rural communities; and (2) not accounting for mortality where HPV-associated cancer was not the underlying cause of death but a contributing factor. This Research Letter provides a clearer picture by analyzing the latest Surveillance, Epidemiological, End Results (SEER) incidence and incidence-based mortality data.

The use of community paramedics in rural communities has been expanded within recent years; however, little is known of whether community paramedics are a valid option in reducing hospitalization for specific procedures. This study assesses reduction of hospitalization for patients who underwent a coronary artery bypass grafting procedure.

Limited access to psychological treatment is a pressing problem in the United States, especially in more rural areas. One potentially underutilized resource is informal care from friends and family members. These authors report on a pilot test of the Friends and Family for Mental Health Program, a mental health skills program developed to enhance informal care and reduce psychological symptoms among informal caregivers.

Despite educational and policy efforts, the projected healthcare professional shortage in the USA is expected to increase in the coming years, with rural and underserved communities among those that will be most affected. For newly graduated clinicians, the juncture between the conclusion of formal training and initial practice in a rural community is a critical time that influences retention. Particular challenges for new healthcare professionals in rural areas include isolation, inexperience, purpose, and community integration. To that end, Mountain Area Health Education Center developed a Rural Fellowship program with the intention of facilitating both the placement and continued development of recent graduates from family medicine and one clinical pharmacy residency program in rural western North Carolina. This Original Research article outlines promising results from the Rural Fellowship program.

Australia’s Great Barrier Reef (GBR), stretching 2300 km along the Queensland coast, has millions of visitors per year. Medical emergencies are not uncommon among visitors to the GBR, and patients often require aeromedical retrieval due to their remote location. Little is known about the clinical characteristics of these patients. This Short Communication describes the characteristics and outcomes of patients experiencing cardiac conditions who were retrieved to Cairns Hospital from locations along the northern GBR.

Pregnancy increases the requirement for iodine by at least 50%. Severe iodine deficiency during pregnancy can result in maternal and fetal hypothyroidism and serious adverse health effects. Birth weight can be affected by slight variations in normal maternal thyroid hormone levels and excess iodine in the diet of pregnant women can induce factitious hyperthyroidism. The few studies available in Latin America have been limited to children in metropolitan areas and did not consider pregnant women in non-metropolitan areas. This Original Research article reports on the prevalence of goiter, iodine deficiency and intrauterine growth restrictionin Indigenous and Afro-descendant pregnant women in six non-metropolitan areas of Colombia.

A gestação aumenta a necessidade de iodo em pelo menos 50%. A deficiência severa de iodo durante a gestação pode resultar em hipotireoidismo materno  e fetal com sérios efeitos adversos à saúde. O peso ao nascer pode ser afetado por pequenas variações nos níveis do hormônio da tireoide e o excesso de iodo na dieta pode induzir ao hipertireoidismo fictício. Os poucos estudos disponíveis na América Latina são limitados a crianças de áreas metropolitanas e não consideram gestantes de áreas não metropolitanas. Este estudo original apresenta a prevalência de bócio, deficiência de iodo e restrição do crescimento intrauterino em gestantes indígenas e afrodescendentes de seis áreas não metropolitanas da Colômbia.

El embarazo aumenta el requerimiento de yodo al menos un 50%. La deficiencia grave de yodo durante el embarazo puede provocar hipotiroidismo materno y fetal, y graves efectos adversos para la salud del binomio. El peso al nacer puede verse afectado por ligeras variaciones en los niveles normales de hormona tiroidea materna y el exceso de yodo en la dieta de las embarazadas, puede inducir hipertiroidismo ficticio. Los pocos estudios disponibles en América Latina se han limitado a niños en áreas metropolitanas y no consideraron a las embarazadas en áreas no metropolitanas. Este artículo de investigación original informa sobre la prevalencia de bocio, deficiencia de yodo y restricción del crecimiento intrauterino en embarazadas indígenas y afrodescendientes en seis áreas no metropolitanas de Colombia.

Inequitable access to primary health care accounts for much of the health gap between Aboriginal and Torres Strait Islander Peoples and the broader Australian population. Innovative, culturally safe strategies to improve access to high-quality chronic-disease care and prevention are needed to address these disparities. Medicare-rebated Indigenous-specific health assessments, or the Health Assessment for Aboriginal and Torres Strait Islander People (Medicare Benefits Schedule Item 715), known as ‘715 health checks’, have been introduced to improve preventative health opportunities and reduce rates of undetected risk factors among Aboriginal and Torres Strait Islander Peoples. Uptake of 715 health checks and follow-up services has been poor to date, prompting the trial of programs that deliver 715 health checks in community events, or ‘Health Check Days’. This Scoping Review explores how community events have been used to increase uptake of Indigenous-specific health assessments.

Maternal morbidity and mortality rates in the USA have increased over the past several decades. The closures of many rural hospital obstetric services across the country between 2004 and 2014 has resulted in greater traveling distances for rural women to access obstetric care, and approximately 25% of rural women give birth at non-local (often urban) hospitals. For rural patients, it is unclear whether delivering at an urban facility is protective against maternal morbidity. This Original Research article compares obstetric outcomes for rural people giving birth in urban and rural hospitals.

This Original Research article presents findings on the long-term impacts of Community Water Fluoridation (CWF) on dental caries in children living in remote and very remote Northern Territory (NT), Australia. Dental caries is one of the most prevalent and preventable diseases among Australian children. Untreated dental caries causes pain, distress, illness and is a leading cause of preventable hospitalisation. Children in the NT experience a higher prevalence and severity of dental caries than children who live in other parts of Australia.  Aboriginal children residing in remote and very remote areas of NT are disproportionately impacted by dental caries compared with non-Aboriginal children. Although CWF is a widely recommended public health intervention to reduce dental caries, the NT has a higher proportion of the population without access to fluoridated drinking water (22%) than the national average (11%).This study yields important findings to underpin government policymaking and public health investment using a life course approach to the prevention of dental caries at a population level.

Men located in rural areas experience a disproportionate level of burden from alcohol and other drug (AOD) use. This is exacerbated by limited access to AOD services in rural areas. One positive development from COVID-19 has been the increased uptake of virtual care, which has expanded the reach of AOD and other services. Self-Management and Recovery Training (SMART Recovery) mutual-help groups, which incorporate principles and strategies from cognitive behavioural therapy and motivational interviewing, are readily available in a virtual format and free to access. This Short Communication reports on the similarities and differences between the experiences of rural and urban men attending online SMART Recovery groups.

Nurses represent almost half of the worldwide health workforce and play a critical role in providing health care, from tertiary through to primary and community-based settings. The inadequate size of the nursing workforce has fundamental consequences for the accessibility and quality of health care provided to communities. It also detrimentally affects the health and wellbeing of the existing nursing workforce and damages community perceptions of health services, further exacerbating attrition and the acceptability and utilisation of health services. This article reviews existing literature that reports rural and remote nurses’ views on what informs the attraction, retention and resignation of the rural and remote nurse workforce.

The emergence of COVID-19, caused by SARS-CoV-2, caused an unprecedented worldwide public health crisis leading to high fatality rates and healthcare system collapse. Less than a year after the first confirmed case of COVID-19 in Ecuador in February 2020, a rate of more than 166 additional deaths per 100 000 people was reported, one of highest rates of COVID-19-related deaths during the first wave in the world. Some communities, particularly those in the Amazon Basin, are highly endangered and vulnerable to public health threats like COVID-19 due to their extreme isolation and inadequate health infrastructure. In Ecuador, Indigenous Peoples make up about 7% of the total population and are primarily located in underserved rural communities. This Original Research article presents the results of a retrospective cross-sectional study of the demographics and SARS-CoV-2 detection rate and viral loads during the first wave of the COVID-19 pandemic in 21 Indigenous communities from Ecuadorian Amazonia, including isolated and endangered Waorani, Siona, Kichwa, Kofan and Shuar communities.

La aparición de COVID-19, causada por el SARS-CoV-2, provocó una crisis de salud pública mundial sin precedentes que condujo a altas tasas de mortalidad y al colapso del sistema de atención de salud. Menos de un año después del primer caso confirmado de COVID-19 en Ecuador en febrero de 2020, se informó una tasa de más de 166 muertes adicionales por cada 100,000 personas, una de las tasas más altas de muertes relacionadas con COVID-19 durante la primera ola en el mundo. Algunas comunidades, en particular las de la cuenca amazónica, están en gran peligro y son vulnerables a amenazas de salud pública como COVID-19 debido a su aislamiento extremo y a una infraestructura sanitaria inadecuada. En Ecuador, los pueblos indígenas representan alrededor del 7% de la población total y se encuentran principalmente en comunidades rurales desatendidas. Este artículo de investigación original presenta los resultados de un estudio transversal retrospectivo con las características demográficas, la tasa de detección del SARS-CoV-2 y las cargas virales durante la primera ola de la pandemia de COVID-19 en 21 comunidades indígenas de la Amazonía ecuatoriana, incluidas aquellas aisladas y en peligro de extinción: Waorani, Siona, Kichwa, Kofan y Shuar.

A emergência da COVID-19, causada pelo SARS-CoV-2, causou uma crise sem precedentes na saúde pública mundial que levou a altas taxas de mortalidade e colapso dos sistemas de saúde. No Equador, menos de um ano após o primeiro caso confirmado de COVID-19, em fevereiro de 2020, foi relatado um excesso de mortalidade de mais de 166 mortes por 100.000 habitantes, uma das mais altas taxas de mortalidade por COVID-19 do mundo na primeira onda. Devido ao seu isolamento extremo e inadequada infraestrutura de saúde, algumas comunidades, particularmente as da bacia Amazônica, são altamente vulneráveis a ameaças à saúde pública como a COVID-19. No Equador, os povos indígenas correspondem a 7% da população, e estão basicamente localizados em comunidades rurais carentes. Este artigo original apresenta os resultados de um estudo transversal retrospectivo sobre a demografia e a taxa de detecção e carga viral do SARS-CoV-2 na primeira onda da pandemia de COVID-19 em 21 comunidades indígenas da Amazônia Equatoriana, incluindo as comunidades ameaçadas e isoladas de Waorani, Siona, Kichwa, Kofan e Shuar.

Colonization and assimilation policies have disrupted the intergenerational transfer of knowledge, which has deeply affected the health and well-being of Indigenous peoples, particularly in areas such as food security and environmental stewardship. The practice of harvesting Niska (goose) is integral to Omushkego Cree cultural traditions, reflecting a holistic approach to health that connects Indigenous knowledge, community well-being, and resilience. In Fort Albany First Nation, women play an important role in preserving the tradition, which provides a nutritious, cost-effective food source, supports the management of overabundant geese populations, and sustains the transmission of linguistic and cultural knowledge. Despite the importance of land-based activities in supporting Indigenous health, there is a need for more studies that center the perspectives of Cree women. This study aims to fill that gap by presenting the insights of Omushkego Cree women who have participated in the Niska program.

Shortages and maldistribution of the general practitioner (GP) workforce, and the subsequent impact on healthcare access and delivery, are long-standing concerns in Australian primary health care, particularly in rural and remote GP practices, where these issues are compounded by professional isolation, uncompetitive remuneration, and viability challenges. Although remuneration, workload and location-related issues of lifestyle, spousal employment and child education are factors in GP retention, characteristics of practice work-tasks may also have a role. This Original Research article analyses the prevalence and associated practice factors involved in the retention of GP registrars in their training practices.

A severe economic crisis and recent global conditions, including the global COVID-19 pandemic, have highlighted the importance of the role of primary health care (PHC), especially in low and middle-income countries. Patient perception of quality of care is an essential component in evaluating health-care delivery. This Original Research article reports on data from PHC Centers in Greece before the last PHC reform, undertaken to offer baseline information about patient experience, support the decision-making processes taking place, and provide valuable input for future policy-making comparisons in Greece.

Remote health services in Australia struggle to recruit and retain enough skilled, dedicated staff to provide a stable service. In very remote primary health clinics, small teams of Remote Area Nurses (RANs), Aboriginal and Torres Strait Islander Health Practitioners and Aboriginal Health Workers provide or facilitate all health care for their local community. Poor personal safety has been identified as a contributing factor to burnout and high turnover of staff and is linked to reduced quality of patient care. Many Work Health and Safety (WHS) recommendations and strategies have been developed for the remote health sector in Australia but there is very little evidence of their implementation. This Original Research study investigates which WHS recommendations have been implemented in very remote primary health clinics in Australia, from the perspectives of RANs.

The increasing proportion of older adults in the world demands greater attention to healthy aging. Sarcopenia, an age-related decline in musculoskeletal system function, can lead to adverse health outcomes and higher health system costs, but inconsistencies in assessment tools means that there is limited clear knowledge about its prevalence. This Original Research article reports on the prevalence of sarcopenia and its associated factors among rural older adults in Brazil using European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria.

O aumento da proporção de idosos no mundo demanda grande atenção para o envelhecimento saudável. A sarcopenia, um declínio na função do sistema musculoesquelético, pode levar a desfechos adversos à saúde e a altos custos aos sistemas de saúde. Contudo, inconsistências nas ferramentas de avaliação indicam que não há clareza quanto à sua prevalência. Este artigo original apresenta a prevalência e os fatores associados à sarcopenia em idosos rurais do Brasil, utilizando o critério do Grupo de Trabalho Europeu sobre Sarcopenia em Idosos 2 (EWGSOP2).

La creciente proporción de adultos mayores en el mundo exige una mayor atención al envejecimiento saludable. La sarcopenia, un deterioro de la función del sistema musculoesquelético relacionado con la edad, puede conducir a resultados adversos y mayores costos del sistema de salud. Por otro lado, las inconsistencias en las herramientas de evaluación nos muestran que existe un conocimiento limitado sobre su prevalencia. Este artículo de investigación original informa sobre la prevalencia de la sarcopenia y sus factores asociados entre los adultos mayores rurales de Brasil utilizando los criterios del Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores 2 (EWGSOP2).

Household food insecurity (HFI) describes inadequate food access, availability, and utilization due to insufficient financial resources and is an important social determinant of health. Other aspects of food security, such as the availability of, and physical access to, healthy foods, are uniquely challenging to achieve in remote regions. This Scoping Review provides a unique global exploration and comment on the literature surrounding HFI in remote and circumpolar remote communities. Through examining initiatives and outcomes that have been conducted to decrease HFI, and factors that contribute, a fulsome picture of the current evidence is created and critiqued. Suggestions both regarding further research, as well as informing current policy based on work done thus far, are made.

Ambulance Services within Australia frequently use a combination of first responders, volunteer ambulance officers (VAOs), registered paramedics, critical care/extended care paramedics and aeromedical rescue services. In rural regions, emergency care may be provided by a blended service of paramedics and VAOs or a complete VAO model. Many maternity units have been centralised to larger regional centres, impacting accessibility of antenatal care for rural and remote communities. Longer travel times are associated with increased risk of out-of-hospital births (OOHBs) and life threatening complications such as postpartum haemorrhage and neonatal mortality.

Registered paramedics perceive a lack of adequate training, exposure and confidence with managing OOHBs, but there is limited research about VAO experiences. This Original Research study investigates VAO perceptions of training, experience and confidence regarding management of unplanned OOHBs.

Australia’s medical workforce problem is primarily one of maldistribution, with both the geographic distribution of doctors and the relative supply of medical specialities not currently meeting the health needs of Australian rural communities. Recent studies from Australian universities that have prioritised recruiting students from the region in which they are located, rather than just the ASGS-RA or MM classifications, have demonstrated promising results for ‘grow your own’ workforce strategies, with students who grew up and also trained in a region being up to 17 times as likely to work in the same region after graduation. With growing evidence supporting strategic ‘grow your own’ approaches to recruiting, training and retaining health professionals from and for underserviced rural communities, there is a need for sound methodologies by which universities with a social accountability mandate can accurately describe their region of rural focus, or ‘footprint’. This Project Report describes the process, outcomes and lessons learned through a project undertaken to formally describe Deakin University’s rural health activity footprint.

Pakistan's government and development organizations aim to accomplish equitable access to family planning services by 2030, in line with Sustainable Development Goals, by enhancing the availability and quality of family planning services, increasing awareness and education, and addressing cultural and social barriers. These endeavors are anticipated to support reproductive health outcomes and lower maternal and infant mortality rates in Pakistan. A first crucial step in facilitating the development of effective policies and programs is to understand the diversity of fertility patterns, family planning preferences, and behaviors that exist. This Original Research article examines the factors influencing contraceptive use and family planning behaviors in rural and urban regions of Pakistan.

Magnesium is required for almost all body system functions, including cardiovascular, neurological, endocrine, musculoskeletal and immune systems. Dysmagnesemia, or disorder in serum magnesium levels (hypermagnesemia or hypomagnesemia), is associated with poor health outcomes in hospitalised patients, including the need for longer hospital stays and increased risk of mortality. This register-based study assessed the prevalence of dysmagnesemia and associated health outcomes among hospitalised patients in the Northern Territory, Australia.

Discharge against medical advice (DAMA), when a patient chooses to discharge themselves before their recommended treatment is complete, occurs in only a small fraction (<2%) of total hospital admissions in Australia but is linked with significant human and financial cost (eg higher rates of mortality and morbidity and significantly higher healthcare costs than non-DAMA cases). Reducing rates of DAMA is therefore an important goal in health service improvement. Factors associated with DAMA include a mix of patient, health service and environmental factors, and can be compounded in rural and remote areas, where health workforce shortages are common. Because a DAMA event signifies a potential breakdown in the patient-provider relationship, perspectives of both patients and providers are important to understand current practice and identify opportunities for improvement. This Original Research study explores healthcare providers' views on DAMA and identifies strategies for preventing and/or better managing DAMA cases.

COVID-19 was the leading cause of maternal deaths in Mexico and Colombia during the pandemic and many Latin American countries reported disruptions to maternal and newborn services. In Guatemala, only 10% of the population is vaccinated and there are many misconceptions about COVID-19 and the vaccine. More information is needed about misconceptions patients might still harbor about the virus and the vaccine. Lay midwives attend the majority of births in Guatemala, including most births at home, and are in an optimal position to offer front-line support to pregnant women and newborns regarding COVID-19. Lay midwives are a particularly important source of information inrural and Indigenous Mayan populations, which disproportionately suffer poor health outcomes. This Original Research article reports on a program of study that aimed to dispel myths about COVID-19 and provide culturally relevant educational activities to low-literacy Guatemalan lay midwives in Peten, which is the largest department in Guatemala, but among the most remote regions and where >60% of residents live in poverty and lack access to basic health care. 

COVID-19 fue la principal causa de muerte materna en México y Colombia durante la pandemia y muchos países de América Latina informaron discontinuidad en los servicios maternos y neonatales. En Guatemala sólo el 10% de la población está vacunada y existen muchos conceptos erróneos sobre el COVID-19 y la vacuna. Se necesita más información sobre conceptos erróneos que aún persisten en los pacientes sobre el virus y la vacuna. Las parteras no profesionales atienden la mayoría de los partos en Guatemala, incluidos gran parte de los partos en el hogar, y están en una posición óptima para ofrecer apoyo de primera línea a las mujeres embarazadas y a los recién nacidos en relación con el COVID-19. Las parteras no profesionales son una fuente de información particularmente importante en las poblaciones rurales e indígenas mayas, que tienen los peores resultados de salud, en relación al resto del país. Este artículo original de investigación informa sobre un programa de estudio cuyo objetivo es disipar mitos sobre COVID-19 y brindar actividades educativas culturalmente pertinentes a parteras no profesionales guatemaltecas con bajo nivel de alfabetización en Petén, que es el departamento más grande de Guatemala, y se encuentra entre las regiones más remotas, donde >60% de los residentes viven en la pobreza y carecen de acceso a atención médica básica.

Durante a pandemia, a COVID-19 foi a principal causa de mortalidade materna no México e na Colômbia e muitos países latino-americanos relataram interrupções nos serviços maternos e neonatais. Na Guatemala, apenas 10% da população está vacinada e existem muitos conceitos errados sobre a COVID-19 e a vacina, sendo necessárias mais informações sobre estes equívocos. As parteiras, que assistem à maioria dos partos na Guatemala, incluindo os domiciliares, estão numa posição ideal para oferecer apoio de primeira linha sobre a COVID-19 às mulheres grávidas e aos recém-nascidos. As parteiras são uma fonte de informação particularmente importante nas populações rurais e indígenas maias, que sofrem com piores indicadores de saúde. Este artigo original relata um programa de estudo que teve como objetivo dissipar mitos sobre a COVID-19 e fornecer atividades educacionais culturalmente relevantes para parteiras guatemaltecas com baixo nível de alfabetização em Peten, que é o maior departamento da Guatemala, mas que está entre as regiões mais remotas, onde >60% dos residentes vivem na pobreza e não têm acesso a cuidados básicos de saúde.

Salmonella spp. is one of the most commonly reported causal agents of bacterial gastroenteritis and a leading cause of foodborne outbreaks globally. It has been estimated that 94% of salmonellosis is transmitted via contaminated food of animal origin, such as poultry and pig meat, eggs and milk. Salmonella  enterica subsp. enterica serovar Give is one of the less frequently isolated serotypes in humans. Between 2007 and 2021, there have been 1874 Salmonella ser. Give cases in European Union and European Economic Area countries. This Original Research study investigates an outbreak of Salmonella ser. Give linked to consumption of a local traditional roast pork recipe in September 2022 in southern Greece.

Agricultural workers around the world face unique stressors, including many factors beyond their control (e.g. weather, predators, markets), and experience higher rates than the general population of mental ill-health, depression and risk of death by suicide. There is also evidence that exposure to pesticides can produce adverse effects on mental health, such as anxiety and depression. This Systematic Review examines the association between pesticide exposure and the incidence of suicide in agricultural workers.

Los trabajadores agrícolas de todo el mundo enfrentan factores estresantes únicos, incluidos varios que escapan a su control (por ejemplo, el clima, los depredadores, los mercados), y experimentan tasas más altas que la población general de problemas de salud mental, depresión y riesgo de muerte por suicidio. También hay evidencia de que la exposición a pesticidas puede producir efectos adversos en la salud mental, como ansiedad y depresión. Esta revisión sistemática examina la asociación entre la exposición a pesticidas y la incidencia de suicidio en trabajadores agrícolas.

Os trabalhadores agrícolas em todo o mundo enfrentam fatores de estresse únicos, incluindo aqueles fora do seu controle (por exemplo, clima, predadores, mercados), e experimentam taxas mais elevadas de problemas de saúde mental, depressão e risco de morte por suicídio do que a população em geral. Há também evidências de que a exposição a pesticidas pode produzir efeitos adversos na saúde mental, como ansiedade e depressão. Esta revisão sistemática examina a associação entre a exposição a pesticidas e a incidência de suicídio em trabalhadores agrícolas.

Globally, rural and remote areas are impacted by limited access to highly skilled physicians. Addressing these shortages requires concerted efforts by medical schools to place medical students on rotation within these communities and for medical students to have a positive experience. Positive experiences within rural rotations has previously been found to be an important factor in medical students’ career intentions. This Original Research study, set in Northern Ontario, Canada, explores what rural preceptors believe contributes to positive rural placements for medical students.

Injury from trauma is the leading cause of death in Australia for people aged 1–44 years. In Queensland, Australia, approximately 40% of residents live in rural and remote areas and face higher rates of morbidity and mortality from trauma than residents in urban settings because of the greater time, distance and resource constraints in accessing emergency care. Each of the 16 hospitals and health services in Queensland are responsible for developing and delivering their own trauma resources. Limited communication and collaboration across the vast service areas often results in inconsistencies in the content, processes, volume and regularity of trauma education provided across facilities. The Queensland Trauma Education (QTE) program was created in 2021 to complement available trauma courses and resources. This article reviews the QTE program and assesses the benefits to clinicians in both the delivery of education and the provision of trauma care.

In Queensland, Australia, people residing in rural and remote locations have poorer access to health care than urban people and nurses working in these settings play a crucial role, often being the first point of contact for people needing care. Although inadequacies in access to, and choice of, maternity care for women living in rural and remote communities have been highlighted in the past, 43% of rural maternity services have closed over the past two and half decades, and remote area nurses (RANs) have been increasingly relied on to provide care to pregnant and labouring women. This Original Research study provides an in-depth description of the lived experience of RANs who care for pregnant women in their role.

Machado-Joseph Disease (MJD) is the most common spinocerebellar ataxia worldwide and has the highest estimated prevalence in affected Aboriginal communities of the Top End of Australia. MJD, or spinocerebellar ataxia 3 (SCA3), is a genetic disease that leads to loss of coordination of all motor functions, for which there is no cure. Within 5 to 10 years of symptoms first emerging, individuals typically become wheelchair dependent and require full assistance for all activities of daily living and have a mean life expectancy of 20 years from symptom onset. Physical activity programs responsive to the culture and lifestyle of families with MJD, and those with degenerative ataxias more broadly, are scarce in Australia and internationally, despite calls for person-centred rehabilitation programs. For Aboriginal people, and other first Nations people internationally, programs are found to fail when views, lifestyle and concepts of cultural and traditional practices are not taken into account. The ‘Staying Strong Toolbox’ is a physical activity and lifestyle program co-designed by Aboriginal families living in Groote Eylandt and Ngukurr, the MJD Foundation and university researchers. This Original Research article presents the results of a mixed-method multiple case study design to determine the feasibility and impact of the ‘Staying Strong Toolbox’ program on walking and moving around for Aboriginal families with MJD in the Top End of Australia.

Rural and remote health services face challenges recruiting and retaining allied health (AH) professionals, despite increasing demand for AH services with the expansion of disability and aged care services, increasingly complex health needs and ageing populations. Postgraduate training is one strategy that can be used to develop skills relevant to rural AH roles. The Allied Health Rural Generalist Pathway (AHRGP) is a postgraduate program that includes coursework and work-based projects throughout a program of study with the aim of growing and sustaining the rural and remote AH workforce. Regional Local Health Networks in South Australia introduced the AHRGP in 2019 as a workforce strategy. This Original Research article presents the first evaluation of the resources and outcomes of the AHRGP using a cost consequence analysis approach.

Cultural disruption appears to be particularly important in determining refugee health outcomes. Given that culture can influence pain experience and expression, Western pain management programs may not be meeting the needs of migrant peoples. Nepali-speaking Bhutanese (Lhotshampa) refugees have a multigenerational history of displacement from their homeland and subsequent countries, separation from their families, persecution and torture, malnutrition and poor health. This accumulation of trauma places Nepali-speaking Bhutanese refugees at significant risk of mental and physical ill-health and it is estimated that up to 56% of Nepali-speaking Bhutanese refugees experience chronic pain. This Original Research article reports the results of a qualitative study exploring conceptualisations and beliefs about pain held by the Nepali-speaking Bhutanese community in rural and regional Australia.

Despite its high-achieving health system, universal health coverage and having the world’s highest life expectancy, Japan faces challenges in providing equitable health care to rural and remote populations. Approximately 10% of Japan's population of over 100 million people live in rural and remote areas (mountains, small islands and peninsulas) and its healthcare system is experiencing increasing healthcare costs, physician maldistribution and an entrenched workforce and training culture in which primary care has lacked formal recognition (until recently) as a specialty medical workforce. The Rural Generalist Program Japan (RGPJ) was established in 2017 to support medical training in rural and remote areas. The program is certified by the Australian College of Rural and Remote Medicine (ACRRM) and registrars who complete training and assessment are awarded the Certificate of Completion of Training jointly by ACRRM and RGPJ. This Original Research article presents the views of RGPJ participants, academics and government officials on the future role of rural generalist medicine in contributing to solutions for rural and island health in Japan.

Breast cancer is the most common cause of cancer-related deaths worldwide. Regular screening and early diagnosis are vital for reducing breast cancer deaths but, in Turkey, despite a screening program that includes mammography every 2 years for women aged 40–69, 75% of women are unaware of the need for mammography. International studies have found that health literacy is a crucial component in predicting knowledge, awareness and decision-making for breast cancer screening, but there is little knowledge of this issue in rural Turkey, where there are particularly low rates of health service access. This Original Research study uses a survey and face-to-face interviews to investigate health literacy levels and breast cancer screening behaviors in a rural area of Turkey.

Inequitable distribution of allied health professionals (AHPs) affects the delivery of rural healthcare services and the retention of rural healthcare professionals. Models of future supply and demand for rural and urban allied healthcare services predict continued widening of the gap between the number of available AHPs and healthcare needs in the USA. This Review article identifies literature related to the rural AHP workforce, specifically that assessing demographics and predicted trends, the person factors (cognitive, physical, and psychosocial), and recruitment and retention.

Approximately 97% of Indigenous peoples live in low- and middle-income countries (LMICs) and, owing to the ongoing effects of colonialism, experience high levels of poverty, discrimination and marginalization, and have poorer access to health care, are more likely to live in ill health and have lower life expectancies at birth than non-Indigenous peoples. This is compounded by a lack of data on Indigenous peoples’ health and needs. Indigenous women in LMICs can experience many barriers to access to maternal health services (antenatal care, postnatal care and childbirth), including the ‘top-down nature’ of interventions, a lack of cultural awareness from providers, language barriers, cost, poor awareness of services, and geographical barriers such as distance and transport. This Integrative Review explores the extent of the published literature on Indigenous women’s access to maternal health services in LMICs from 2018 to 2023. The results update a previous review, and allow the authors to comment on how barriers might have changed, new barriers that have been identified and the WHO’s aim of achieving Universal Health Coverage by 2030.

Farming is physically demanding and may be associated with a higher risk of joint diseases including osteoarthritis. However, there is sparse literature on the association of farming and risk of osteoarthritis. In this Original Research study, Rahmanzadeh Koucheh and colleagues examined administrative databases in Alberta, Canada, to evaluate the association between farming and osteoarthritis. They followed over 350,000 adults over a 20-year period and observed a higher risk of osteoarthritis in farm and non-farm rural residents compared with urban residents. Additional work is required to examine factors associated with the higher risk and interventions that may reduce this risk.

In South Africa, around 40% of the population lives in rural areas. The responsibility for rehabilitation services in rural and underserved areas frequently rests on a group of novice practitioners completing a year of compulsory Community Service after graduation. Many of these therapists are placed in settings where services are underdeveloped or where they are the only occupational therapist. Previous studies have reported that they are often provided inadequate management, support, and supervision, and experience increased vulnerability to burnout. One area of practice that these novice therapists have reported as being challenging is hand therapy, of which there is substantial demand because of high levels of hand trauma largely resulting from interpersonal violence, road accidents, and work-related injuries. This Original Research article reports on participants’ experience of a virtual Community of Practice (CoP) for providing support and sustained learning partnerships for novice, generalist occupational therapists delivering hand therapy services in rural and underserved areas.

Health status between urban and rural areas is particularly important in the context of regional equity. Owing to factors like inequitable distribution of healthcare providers, the distance to access healthcare services and socioeconomic factors, people living in rural and remote areas are often at a disadvantage relative to people in urban areas for access to health resources and health outcomes. Understanding the healthcare and financial burden of death and how this differs in rural and urban areas is an important, but understudied, part of the equity equation. The cost of health care for people before they die depends on factors including the type of treatment, geographic location, and socioeconomic status of the individual. Catastrophic health expenditure (CHE), calculated as the ratio of out-of-pocket expenditure to the household's ability to pay, is a useful indicator of household financial burden. This study examines ability to pay and equity of CHE between households of deceased members in urban and rural areas of South Korea.

Podcasting has grown dramatically over the last two decades. Health-related podcasts provide a way of making health information available to a wide audience at low or no cost. They often facilitate discussions from medical professionals and have been used to increase health literacy and deliver educational resources to a range of clinical and non-clinical populations. A wide variety of mental-health-related podcasts are available to the public. Recent research has demonstrated that people who listen to mental-health-themed podcasts hold fewer stigmatizing attitudes than the general population, but little is known about listeners’ experiences. This Original Research study sheds light on the motivations, listening habits and outcomes for mental health-related podcast listeners.

The Barkly, in the Northern Territory, Australia, is a highly creative region, with seven art centres and a range of creative practices across its multicultural population. Alongside the Barkly’s cultural and artistic strengths, there exists extreme socio-economic disadvantage, with indicators of homelessness, domestic violence, unemployment, poverty and ill health at much higher than national Australian averages. The region is very remote - extreme weather conditions are experienced for long consecutive periods and distances between communities are many hundreds of kilometres on roads of very poor condition. Discussions of health and wellbeing are prefaced with First Nations’ conceptions of health due to the authors' positionality and the significant proportion of the Barkly Region’s population who are First Nations’ peoples. This Original Research paper offers a snapshot of the overall arts-health ecology in the Barkly in order to advance our understanding of how the arts can be inextricably intertwined with social, cultural, political and place-based health determinants in remote contexts. These insights are illuminating for health policies and practices in remote regions more broadly.

Māori, the Indigenous Peoples of Aotearoa New Zealand, are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD treatments than non-Māori New Zealanders. Rural Māori experience additional barriers to treatment access, poorer health outcomes, and a greater burden of CVD risk factors, compared to Non-Māori and Māori living in urban areas. Inequities in CVD outcomes and access to CVD healthcare for rural Māori are similar to those experienced by rural Indigenous Peoples internationally. Despite these inequities, literature exploring access to CVD healthcare for rural Indigenous Peoples is limited. This Scoping Review identifies and summarises literature that explores the barriers and facilitators influencing access to CVD healthcare for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the findings within an equity-and-Indigenous-rights based framework.

The current economic crisis is resulting in more Australian families having to spend more money out of their own pocket for health care, known as out-of-pocket healthcare expenditure (OOPHE). When finances are tight, families forgo food or do not attend medical appointments just to get by, which can worsen chronic conditions. In this Original Research article, the authors explore OOPHE impacts for Aboriginal patients and families living in the Far West of South Australia.

Skin and soft tissue infections (SSTIs; e.g. cellulitis, wound infections, boils and abscesses) present a substantial financial burden on Australia’s health system. A single episode of hospitalisation for SSTIs costs at least AU$670 per day and individuals living in rural and remote Australia often require aeromedical retrieval service to access emergency department and inpatient care, which also represents a sizeable financial cost. The Torres and Cape Hospital and Health Service (TCHHS) is the main, publicly funded health service in the Torres Strait, a body of water bounded by mainland Papua New Guinea to the north and Cape York, Queensland, to the south that includes 18 inhabited islands. Approximately 64% of the population of 4500 people serviced by the TCHHS identify as Aboriginal and/or Torres Strait Islander. This Short Communication defines the health service utilisation and health system costs associated with SSTIs in the Torres Strait in order to identify ways of improving the quality of regional healthcare delivery. 

Survey tools are commonly used to collect patient experience data to monitor, evaluate and improve health services and health outcomes, but the quality of data collected can be compromised in contexts where languages and cultures are different to those in which the surveys were developed. Health service improvement is imperative to address persistent disparities in health outcomes between First Nations and other Australians. Best-practice models emphasize both the time required for adapting surveys and the need for co-design through shared expertise in language, culture and context. This collaborative qualitative study explored the acceptability, relevance and translatability of two patient-experience survey tools intended for use with speakers of First Nations languages in the Northern Territory, Australia, where more than 100 First Nations languages and dialects are spoken, and the majority of First Nations residents speak one or more of these languages at home.

In many countries, the suicide rate is higher among farmers than in the general population, but farmers seem to seek help less frequently. In France, the Mutualité Sociale Agricole has developed several schemes to help farmers in difficulty (discussion groups, retraining assistance, subsidy for a replacement, and an anonymous telephone helpline) and most farmers are registered with a GP and receive reimbursement for medical consultations and treatment costs. Yet, French farmers consult their GPs less than other workers and have a higher suicide mortality rate than all other active socio-professional categories. This Original Research study analyses the perceptions of farmers in Ille et Vilaine, Brittany, about suicide and the help offered to farmers at risk of suicide.

Significant differences exist in health outcomes between rural and urban areas in Aotearoa New Zealand (NZ), and rural workforce issues (including heavy reliance on overseas-trained doctors and a maldistribution towards urban areas) compound these disparities. The medical programme at the University of Auckland has implemented several approaches to address these pressures, including providing 25–50% of general practice placements in a rural setting and admitting students of rural origin via the Regional Rural Admission Scheme (RRAS),  but there has been little indication of an increase in medical students wanting to pursue a rural career. This Original Research article reports on the results of interviews with key stakeholders that sought to identify the processes required to develop a rural strategy, including possible facilitators and challenges that need to be addressed.

Acquired brain injury (ABI) includes conditions like stroke and traumatic brain injury, and is one of the leading causes of disability in working-age adults worldwide. Depending on the extent and location of the injury, individuals with ABI may experience a complex combination of deficits in motor, sensory, cognitive, perceptual, and emotional domains and often require proactive services and persistent professional support after discharge home to help them overcome diverse challenges related to family life, social participation, the return to work, and finances (known as ‘community integration’). This scoping review maps the current research literature to identify existing models for the provision of rehabilitation services that promote community integration in rural home-dwelling adults with ABI.

The shortage and maldistribution of healthcare professionals, such as doctors, nurses and allied health professionals, continues to impact the health and wellbeing of rural and remote communities globally. Pharmacists, who do much more than dispense medication, provide access to primary health care services including vaccinations, chronic disease management, wound care, oral health care and mental health support. They are an important part of the overall health care picture and, in some cases, may be the only health professional locally available for people in rural and remote communities. This original research study develops a deeper understanding of pharmacists’ perspectives concerning factors influencing their recruitment and retention in rural and remote communities.

Infectious diseases associated with poverty disproportionately impact rural populations with limited access to health care. Cutaneous leishmaniasis (CL) is caused by infection with leishmania parasites and spread by the bite of sandflies; it is challenging to control owing to its epidemiological, clinical, and biological complexity. Colombia reported the second-highest number of CL cases in the Latin America region in 2020. Community capacity building and education is needed to achieve effective prevention and control. This article presents the learning process of implementing a capacity-building program, which sought to provide tools to the community to improve CL prevention and control in the municipality of Pueblo Rico, Colombia

Doenças infecciosas associadas à pobreza têm impacto desproporcional em populações rurais com limitado acesso à atenção em saúde. A Leishmaniose Cutânea (LC) é causada pela infecção por parasitas leishmania e é transmitida através da picada de flebotomíneos; é um desafio controlá-la devido à sua complexidade epidemiológica, clínica e biológica. Em 2020, a Colômbia notificou o segundo maior número de casos de LC na América Latina. A capacitação e a educação da comunidade são necessárias para alcançar a prevenção e o controle eficaz da LC. Este artigo apresenta o processo de aprendizagem para a implementação de um programa de capacitação que buscou fornecer ferramentas à comunidade para melhorar a prevenção e o controle da LC no município de Pueblo Rico, Colômbia.

Las enfermedades infecciosas asociadas con la pobreza afectan de manera desproporcionada a poblaciones rurales con acceso limitado a atención médica. La Leishmaniasis Cutánea (CL) es causada por una infección por parásitos leishmania y se transmite por la picadura de mosquitos flebótomos. Su control es difícil debido a su complejidad epidemiológica, clínica y biológica. Colombia reportó el segundo mayor número de casos de LC enLatinoamérica en 2020. Se necesita educación y desarrollo de capacidades comunitarias para lograr una prevención y un control efectivos. Este artículo presenta el proceso de aprendizaje de la implementación de un programa de desarrollo de capacidades, que buscó brindar herramientas a la comunidad para mejorar la prevención y el control de LC en el municipio de Pueblo Rico, Colombia.

The need to address racism in Australian health services is recognised at every level of national and state governance. Despite this, a barrier to developing antiracism is the strong emotional reactions that white people have when confronted with the topic of racism. These reactions, a result of implicit bias and intergenerational social and cultural learning, shut down critical reflection about racism, and can interrupt antiracist efforts and uphold white supremacy. Although documented mostly in universities, these reactions have been observed in the wider community, so it is likely they occur in workplaces too. With antiracism now an inherent part of professional practice guidelines in health, it is necessary to resolve this gap in the research. This Original Research article identifies how emotional reactions affect antiracism and decolonising health service delivery in Aboriginal communities.

Internationally, racism, historical and present trauma and settler colonialism are catalysts for compromised health and well-being in a landscape of community and family dysfunction. The health impacts of racism are well documented in the lower life expectancy, burden of disease and elevated levels of psychological distress experienced by First Peoples. There is evidence to suggest that the ability of health professionals to integrate cultural safety into their practice is intrinsic to dismantling racism and to improving the health of First Peoples and other marginalised groups but little is understood about how health professionals understand racism in the context of providing culturally safe care. Utilising international research, this Scoping Review explores how interdisciplinary health professionals in the aged-care sector in rural areas understand and respond to racism and understand and provide culturally safe care.

Rural and remote Indigenous communities are disproportionately affected by diabetes-related foot disease (DFD), one of the most prevalent causes of global hospitalisation and morbidity. Early identification of wounds and multidisciplinary management can significantly reduce amputation rates, but there are important barriers to health care for rural Indigenous communities, including access to culturally appropriate care, distance to care, dislocation from family and cultural support, exposure to racism, and poor communication with healthcare professionals. Telehealth has been identified as a strategy to improve access to health care for rural and remote communities and may address some of these barriers, but there is little research exploring the use of telehealth in the management of DFD in Indigenous people. This Original Research study investigated experiences of rural and remote Aboriginal and Torres Strait Islander people with DFD utilising a newly established real-time video-based telehealth service.

Rural healthcare human resources challenges persist, despite the existence of many different initiatives to increase rurally focused training opportunities. This Commentary makes the case for a paradigm shift away from specialist curricula and training in urban centres, towards decentralization of training and capitalizing on the opportunity to increase rural practitioner mentorship of trainees. The concept of rural training in place is introduced, enabled by distance learning technology, to provide an immersive, longitudinal, rural training model, that would allow learners to build and maintain community integration throughout training.

Inequalities often exist between urban and rural areas in health status and in the distribution of social determinants such as income, education and employment. Monitoring regional health inequalities can provide evidence and support for policies to reduce inequality. Much point-in-time evidence exists for Australia, but this Original Research article reports on analyses of Public Health Information Development Unit (PHIDU) data to investigate the nature of change in inequalities over 3 decades and to categorise local government areas into remoteness categories. Improved understanding of what has changed over time (or not) and diversity in health and social determinants of health both within and between remoteness categories can inform more effective policy and services to rural and remote areas.

Iron deficiency anaemia is a particular risk for pregnant women because additional iron is needed to meet the needs of the growing fetus and to supply the increased maternal red blood cell mass. Sub-optimal levels of iron during pregnancy are associated with adverse outcomes including low birth weight, preterm birth and, in more severe cases, maternal death. Reported figures of maternal and infant mortality remain high in rural populations of low-income countries. This study determined the iron status of rural-dwelling Nigerian women in the second and third trimesters of pregnancy and predicted their risk of giving birth to babies with sub-optimal iron endowment.

Canada’s rural population has diverse geographic and demographic features and accounts for 18.9% of the entire population. Longstanding inequities in service delivery for rural people, especially with respect to addiction and mental health, lead to delay in diagnosis and treatment, impacting illness severity and outcomes. Indigenous people, who are highly represented in rural communities, have additional risk factors related to colonialism, and historical and ongoing trauma. This Review article provides a national, broad look at the issue of non-psychotic mental illness across rural Canada. As well as speaking to the significant weight of the problem, factors influencing mental health across rural and remote communities and promising practices for care are described.

Addressing rural health issues requires concerted efforts by governments and other organisations to improve the health outcomes of rural populations. It would appear self-evident that young healthcare professionals (HCPs) should be attuned to this and be ready to play a meaningful role. It is, therefore, important to understand their perspectives on the current state of rural health care, the future of rural health care, and their future role in making a difference in the lives of people living in rural communities. This Original Research article is the first to explore rural health issues globally from the perspectives of young HCPs.

During the COVID-19 pandemic, remote consultations (telephone and video) have been increasingly used as an adjunct to traditional healthcare delivery techniques for management of patient conditions, assessment, treatment, monitoring and diagnosis. Not all doctors, even those in rural and remote areas where telehealth has been used for over 20 years, feel sufficiently prepared by medical education courses to deliver remote care. An online survey of Australian College of Rural and Remote Medicine (ACRRM) members was used to establish the training needs of rural doctors for the provision of remote consultations and, subsequently, to develop an online scenario-based training program (the Telehealth Clinical Skills Program, TCSP). This article reports on the outcomes of the TCSP.

The number of rural otolaryngology - head and neck surgery (OHNS) - providers is decreasing annually in Canada, the USA and Australia. Underserved and vulnerable populations are less frequently diagnosed with common otolaryngologic disorders and come to clinical attention with advanced forms of disease. In Northern Ontario, timely access to medical specialties such as OHNS is further challenged by long wait times and long distances to services. New models of care delivery are required that are efficient, cost effective and tailored to the needs of the population. This Project Report characterizes patient demographics, common clinical diagnoses and barriers to accessing otolaryngology services in a remote Northern Ontario setting, and describes a care model that provides multi-subspecialty otolaryngology services to a remote community.

Respiratory disease, usually acute hypoxaemic respiratory failure (AHRF), is the predominant reason for paediatric retrievals from remote areas in northern Australia. AHRF requires oxygen treatment using nasal high flow (NHF) therapy, but although the use of NHF therapy is ubiquitous in Australian tertiary hospitals, implementation is inconsistent in remote Australian hospitals and there is no clear guidance for its use in limited resource environments. This Original Research study developed a guideline for the use of NHF therapy in three remote hospitals in Queensland, Australia.

In South Korea, primary healthcare services are predominantly delivered through public health centers and private clinics (PCs). Approximately 98% of outpatient visits occur at PCs, which are concentrated in large cities. During the COVID-19 pandemic, primary healthcare providers faced financial challenges and potential closures due to social distancing measures and patient cancellations of clinic visits out of fear of infection. Since any changes in the number of PCs can have a significant impact on residents' access to health care, it is important to understand these pressures and closures, particularly in rural areas. This Short Communication considers spatial factors and the changes in PC openings and closures in urban and rural South Korea.

Dementia is the second leading cause of death in Australia and is currently responsible for 4.4% of the total burden of disease in the country. To identify gaps and unmet needs within the health and social care system and potentially improve the quality of care and outcomes for people living with dementia in rural and remote areas, this study investigated the needs of people living with dementia and their informal or formal care-givers in Gippsland, a rural region of Victoria, Australia. Although there are services and supports available for people living with dementia, accessing them can be complex and the wait time can be several years. People living in rural and regional Australia often face multiple additional barriers to accessing health and social care services.

People from rural riverside populations of the Amazon travel greater distances to access health care than urban people, have access to fewer dentists per individual, are less likely to have water fluoridation and tend to experience higher prevalence of dental caries and tooth loss. In Brazil, to increase access to health services for rural people, Fluvial Family Health Teams (FFHT) of health professionals visit many riverside communities monthly in a mobile unit to provide primary health care, including oral health and dental care. This study assessed the use of dental services, and the factors contributing to dental health access, by adults living in rural riverside areas covered by an FFHT.

Las personas de poblaciones rurales ribereñas del Amazonas viajan mayores distancias para acceder a la atención médica que las personas urbanas, tienen acceso a menos dentistas por persona, tienen menos probabilidades de acceder a fluoración del agua y tienden a experimentar una mayor prevalencia de caries dentales y pérdida de piezas dentales. En Brasil, para aumentar el acceso a los servicios de salud para la población rural, los Equipos de Salud Familiar Fluvial (FFHT, por sus siglas en inglés) visitan mensualmente muchas comunidades ribereñas en una unidad móvil para brindar atención primaria de salud, incluida salud y atención dental. Este estudio evaluó el uso de servicios dentales y los factores que contribuyen al acceso a la salud dental por parte de adultos que viven en zonas rurales ribereñas con cobertura de un FFHT.

Residentes de áreas rurais ribeirinhas percorrem distâncias maiores do que populações urbanas para acessar os serviços de saúde, têm menos dentistas por habitante, menor probabilidade de acesso àágua fluoretada e possuem maiores prevalências de cárie e perda dentária. No Brasil, para aumentar o acesso aos serviços de saúde por populações rurais, Equipes de Saúde da Família Fluvial visitam mensalmente comunidades ribeirinhas em uma unidade de saúde móvel para prover atenção primária em saúde, incluindo a saúde bucal. Este estudo avaliou a utilização dos serviços de saúde bucal e os fatores contribuintes para este acesso por adultos moradores de comunidades rurais ribeirinhas cobertas por uma equipe de Saúde da Família da Família Fluvial.

Access to health care for rural and remote Australians remains an issue, despite continued efforts to improve the distribution of the medical workforce. Numerous studies have shown that rural experience for medical students, particularly if they have a rural background, is effective in recruiting and retaining a rural health workforce. Until recently, this has involved short-term or extended rural clinical school placements. The Murray-Darling Medical Schools Network (MDMSN) has established a network of rurally based medical programs in New South Wales and Victoria in which students can complete the entirety of their medical degree in a rural area. The MDMSN offers a unique opportunity to explore the effect of complete rural immersion during medical school on subsequent rural practice. This article describes the establishment of a research collaboration to undertake multi-institution and longitudinal research into rurally based end-to-end medical training programs and their impact on rural workforce maldistribution.

In South Africa, only 30% of healthcare workers provide publicly funded health care to more than 40 million people who are uninsured and constitute approximately 84% of the population. In addition, rural areas have historically experienced a lack of access to healthcare providers, leading to poorer health outcomes than in urban areas. To address health worker staff shortages at rural district hospitals in KwaZulu-Natal Province, the Umthombo Youth Development Foundation (UYDF), has been recruiting and supporting rural-origin health science students with the intention that graduates would work in rural areas on completion of their studies. This Original Research study determined the effects of retention factors on whether rural-origin UYDF graduates chose to work in a rural or urban, public or private setting.

Rural people in the USA, 20% of the population, suffer higher all-cause mortality and are more likely to die of each of the 10 leading causes of death than urban counterparts. They are more likely to be uninsured, live in poverty, and be exposed to unique occupational and environmental toxicities. The ability to identify and address these disparities is directly dependent on the quality of rurality measurements, one of which is Rural–Urban Commuting Area (RUCA) Code. Although basing rurality on commuting distance may adequately measure accessibility of healthcare services, it might miss health-related behaviors and socioeconomic effects. A measure of rurality that considers individual’s perceptions of their community identity while maintaining efficiency for large-scale research is needed to better conduct patient-centered healthcare research. This study examined the concordance between people's self-identification of rurality and their ZIP code-derived RUCA of rurality among a nationally representative sample and determined patient-centered RUCA-based classifications of rurality and urbanicity.

Uruguay has an important livestock industry (cows, sheep, poultry, pigs). Predator attacks on productive species generate great concern for animal welfare and also cause economic losses for farmers but little is known about how predator attacks on productive species impact the mental health of farmers. This study explored how predator attacks on productive species during 2021 influenced the psychological distress of farmers in rural Uruguay.

Uruguay tiene una importante industria ganadera (vacunos, ovinos, avícola, porcinos). Los ataques de depredadores al ganado generan gran preocupación por el bienestar animal, pero también causan pérdidas económicas a los agricultores, y se sabe poco sobre cómo estos ataques impactan su salud mental. Este estudio exploró cómo los ataques de depredadores a estas especies productivas durante 2021 influyeron en la angustia psicológica de los agricultores de las zonas rurales de Uruguay.

O Uruguai possui uma importante indústria pecuária (boi, ovelha, ave, porco). Ataques de predadores às espécies de criação causam grande preocupação para o bem-estar animal, assim como resultam emperdas econômicas para os pecuaristas. Entretanto, pouco se sabe sobre como os ataques às criaçõesimpactam a saúde mental dos pecuaristas. Este estudo avaliou como o ataque de predadores àsespécies de criação no ano de 2021 influenciou o sofrimento mental de pecuaristas em áreas rurais do Uruguai.

Surgical care is limited in many rural areas, with a shortage of general surgeons contributing to this gap in services. This qualitative study explores the meanings surgeons associate with community characteristics to better understand the role that community plays in surgeons' practice location choices. Reflections around themes of physical environment symbolism, health resources' relationship to scope of practice, and overlap of professional and personal roles differed between rural and urban surgeons. The authors suggest that educators and rural healthcare organizations can improve recruitment and retention by better preparing potential rural surgeons for the expected role overlap and highlighting the value of the unique physical environment found in rural areas.